=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982885364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELEME CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 11/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10395 DEMOCRACY LN STE A
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-273-0573
-----------------------------------------------------
Fax | 703-273-7056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10395 DEMOCRACY LN STE A
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-273-0573
-----------------------------------------------------
Fax | 703-273-7056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. VENUS A. SELEME
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 703-273-0573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | VA1957
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------